|
ACC,D® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
<br /> 5/17/2024
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> CONTPRODUCER NAME: Project Team
<br /> Arthur J. Gallagher Risk Management Services, LLC PHONE FAX
<br /> 595 Market Street JA/C.NcFxt); (A/c,Not:
<br /> Suite 2100 E-MAIL
<br /> SS: D I g ^�I \/Dr i ed by NAIC#
<br /> San Francisco CA 94105 tcs)QI ��R/
<br /> e#:OD69293 INSURE, A: ert Mutal Fire surance Comps y 23035
<br /> INSUREDINSURE i 1: IfI" 1®'I 1 �� �0 16535Swinerton Management&Consulting Ing_I_eU05
<br /> 16798 West Bernardo Drive INsur.iR c. S
<br /> tarr Indemnity&Liability Company 38318 _
<br /> San Diego, CA 92127 INS'RERD: 4r�io 6.2733588
<br /> ItJtlf;2KE: atau..^�'Jrancompany V V 26387 _
<br /> cevedo .NSURERF: ? Q /� Q n7t
<br /> COVERAGES CERTIFICATE NUMBER:217249/J2 1 J.�V.-T(REV�6fOAV •
<br /> MtJ+MBIER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR ADDL SUBR POLICY EFF POLICY EXP '
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDDM'YY) LIMITS
<br /> B X COMMERCIAL GENERAL LIABILITY Y Y GL0023224707 8/1/2023 8/1/2024 EACH OCCURRENCE $2,000,000
<br /> DAMAGE RENTE
<br /> CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $1,000,000
<br /> MED EXP(Any one person) $N/A
<br /> PERSONAL&ADV INJURY $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
<br /> POLICY X E LOC
<br /> PRODUCTS-COMPlOPAGG $4,OOD,DDO
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY Y Y AS2661066493023 8/1/2023 8/1/2024 COMBINED SINGLE LIMIT $2,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> - OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> _ AUTOS ONLY AUTOS ONLY (Per accident) $
<br /> X Comp/Coll X Ded:SICK $
<br /> C UMBRELLA LIAB X OCCUR Y Y 1000585239231 8/1/2023 8/1/2024 EACH OCCURRENCE $5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE
<br /> AGGREGATE $5,000,000
<br /> DED RETENTION$ $
<br /> D WORKERS COMPENSATION Y WA666D066493033 8/1/2023 8/1/2024 X
<br /> MOTE EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> E Professional Liab E00653650600 11/1/2022 8/1/2024 Each Claim/Agg limit $2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> SB Job#24104009
<br /> RE:City of Santa Ana,Construction Management&Inspection Services,New Aquatic Facility at Memorial Park
<br /> ADDITIONAL INSURED(S):City of Santa Ana,its officers,agents,employees,consultants,special counsel and representatives.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PRC\
<br /> Executive Director Public Works Agency Risk M„negern Divtcttn
<br /> a o Hz,
<br /> `g~
<br /> 20 Civic Center Plaza (M-43) REVIEWED&APPROVED BY:
<br /> P.O. Box 1988 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92702 Orkti--- `I fftt4l�P91:1 114 4 R�e(�r,,lo
<br /> /4. : '
<br /> ��rr Risk Management Specialist
<br /> ©1988-2015 ACORD /
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|